System for clinical examination of visual functions using lenticular optics or programmable displays

ABSTRACT

A system having one or more lenticular units and more supplementary parts without lenticular properties. The lenticular units consist of lenticular plates that are capable of visualizing various clinically relevant examination objects. In all the examination positions, the system may visualize a fixation area that is shown alone or together with clinically relevant examination objects targeted at the examination of clinically relevant visual functions. Supplementary parts with various optical properties may be fixed or be moved relative to the lenticular units. Various clinically relevant examination objects may be visualized for the right eye and the left eye in that the examination objects of the system are provided with different colors or light polarizations and using eyeglasses with a differently colored glass for the right eye and the left eye or with polarization filters with a different direction for the right eye and the left eye.

FIELD OF THE INVENTION

The present invention relates to a system, which may be used forfunctional examination of scotoma and metamorphopsia in the monocular orbinocular visual functions with a view to early detection and control ofpathological changes in the visual system.

BACKGROUND OF THE INVENTION

Visual acuity is typically measured with a functional test of the mostcentral part in the visual system, and relates to the function of foveaof the retina and the nerve and brain function related to this area.Many early diseases of the visual system do not change the visualacuity, but rather change the function in smaller or larger areas of thevisual field or change the binocular vision. There is often asignificant discrepancy between objective tests, visual acuity andfunction in the visual field.

The most common eye diseases affecting the central visual field are AgeRelated Maculopathy, Diabetic Retinopathy and Glaucoma. To discover andto follow treatment of these eye diseases are utmost important.

Among doctors, ophthalmologists, opticians and other individuals whoperform examinations of visual functions, there is an unmet need withrespect to the ability of examining clinically relevant visual functionsin the central visual field and binocular vision by means of simplemethods. In addition, there is a need for self-examination among peoplewho have an increased risk of diseases in retina, visual pathways andbrain, and among patients who have previously had diagnosed suchdiseases and are at risk of progression. If these patients themselveshave the possibility of discovering early pathological, functionalchanges in the visual system, or discovering important clinical changesdetected previously, prevention or treatment may be initiated quickerand with better results.

Visual functions that may advantageously be examined comprise:

-   -   the visual field from 0 to 10 degrees    -   the visual field from 10 to 25 degrees    -   Binocular visual functions.

The central part of the visual field within a distance of 10 degreesfrom the center corresponds to most of the macular area in the centralpart of the retina of the eye. Some visual functions in this area may beaffected in different ways by diseases in the macular area of the retina(maculopathy) or by changes in front of or below this area of theretina. These diseases may involve small defects (scotomas) in thevisual field (FIG. 1), because sensory cells, nerve cells or nervethreads in this area have ceased or depressed function. In addition,changes in the microstructure of the retina or other impact on thesensory cells of the retina may occur. This may result in metamorphopsia(FIG. 2), where straight lines are seen as broken, bent, wavy,vibrating, twisted or colored lines. Metamorphopsia is a typicalsymptom, which can often be related to functional disturbances in theretina. The visual perception of scotomas and metamorphopsia ismodulated by dynamic changes in the plasticity of the brain.

Some of the causes of functional changes in the macular area in the formof scotomas and metamorphopsia may be membranes or obscurities in frontof parts of the macula. Holes in the retina, oedema, bleeding,inflammation, toxic impact, tumor formation or membrane formation andin-growth of new blood vessels (neovascularization) in the macula orjust below the macula (subretinal neovascular membranes) may be othercauses.

Pathological visual functions in the visual field from 10 to 25 degreesmay be caused by glaucoma, diseases in the retina, visual nerves, andvisual pathways and in the brain.

Pathological binocular functions may occur, if the visual developmentdoes not proceed normally, after traumas, pathological changes in eyesand eye surroundings, chemical impacts, or diseases which affect thenormal control and regulation of the binocular vision.

Known Examination Systems

With various forms of visual field examination (perimetry), it ispossible to examine various parts of the visual field. To this end,computer-controlled, high-technological instruments (automaticperimetry), which lend themselves to stationary use, are frequentlyemployed. Functional impairment or functional cessation in some areas ofthe visual field may be detected with these instruments. But, it is notpossible to detect the special changes in the form of metamorphopsia(FIG. 2) in this manner.

Preferential Hyperacuity Perimeter (Carl Zeiss Meditec) U.S. Pat. No.6,656,131, expressly incorporated herein by reference, uses a computerand a monitor, it being possible with hyperacuity objects to detectmetamorphopsia in the central and paracentral areas of the macula. Thismethod requires relatively costly and stationary equipment.

In 1947, Marc Amsler introduced various charts for the examination ofthe central visual field within 10 degrees. The chart most used has a100 mm square field, which is divided by vertical and horizontal linesthat form 400 squares of 5 mm each. The lines may be black on a whitebackground, white lines on a black background or colored lines on awhite, dark or colored background. In the monocular examination, thechart is held at a distance of 30 cm from the eye, so that each squarecorresponds to 1 degree of the visual field. The center of the chartincludes a fixation point, which the patient is to fixate constantly. Inuse, the patient tries to indicate whether all lines and squares can beseen, or can be seen with the same clarity, or whether there are lineswhich are perceived as broken, bent, wavy or twisted lines. Then, thepatient tries to draw the seen changes on the chart.

See Also, (WO/2010/023470) Ophthalmic Diagnostic Apparatus,(WO/2008/020252) Ophthalmic Diagnostic Apparatus, (WO/2004/000108)Computer-Based Visual Field Testing, (WO/2003/092481) CharacterizationOf Visual Field Defects, (WO/2003/070089) Method And System ForAssessing Eye Disease, (WO/2003/061521) Methods And Apparatus ForObserving And Recording Irregularities Of The Macula And Nearby RetinalField, (WO/2003/028534) System And Method For Full Field OscillatingStimulus Perimeter, (WO/2002/028266) Methods Devices And Systems ForDetecting Eye Disease, (WO/2002/005704) Virtual Reality PeripheralVision Scotoma Screening, (WO/2001/072212) Computer-Based 3d VisualField Test System And Analysis, (WO/1999/026524) Method And ApparatusFor Measuring And Correcting Metamorphopsia, (WO/1998/017168) A MethodOf Corneal Analysis Using A Checkered Placido Apparatus,(WO/1997/024058) Ophthalmological Self-Test Unit For Evaluating MacularDegeneration, (WO/1996/034555) Method And Apparatus For Central VisualField Mapping And Optimization Of Image Presentation Based Upon MappedParameters, (WO/1996/032880) Automated Pocket-Sized Near Vision Tester,(WO/1987/004264) System And Method Of Detecting Visual Field Defects, USApplication Nos. 20090273758, 20090231545, 20090143685, 20090109399,20080309879, 20080309878, 20080137036, 20070268455, 20070200927,20050261557, 20050122477, 20040193070, 20040125341, 20040075814,20040046934, 20030223038, 20030212310, 20030117582, 20030081176,20030020873, 20030002014, 20020042580, 20020024634, 20010055095, U.S.Pat. Nos. 7,771,051, 7,425,067, 7,614,746, 7,275,830, 7,220,000,7,101,044, 6,769,770, 6,742,894, 6,736,511, 6,656,131, 6,585,376,6,578,966, 6,494,578, 6,450,641, 6,213,605, 6,108,634, 5,892,5705,883,692, 5,841,511, 5,838,422, 5,646,710, 5,596,379, 5,589,897,5,880,814, 5,568,209, 5,416,540, 5,139,030, 5,121,981, 4,826,308,4,818,091, 4,798,456, each of which is expressly incorporated herein byreference.

The clinical use of Amsler charts involves various problems:

-   -   a) Many people have difficulty in maintaining the central        fixation, habitually or because of a central scotoma. When they        move the fixation to other locations on the chart, then small        changes in the lines of the squares are not discovered, or they        are registered wrongly.    -   b) It is difficult for many people to mark the changes, which        they see on the chart.    -   c) When a person has fixated a few seconds on the fixation        point, then the brain begins to modulate in the visual field.        The constant fixation and all the many squares and lines trigger        crowding (multiple lines in the grid interfere with the        perception), perceptual fading (Troxler effect where perifoveal        stimuli fade or disappear), perceptual filling in (scotoma        become replaced by their background and small defects in        straight lines are completed) and hyperacuity (displaced lines        are aligned). This means that some scotomas and metamorphopsia        cannot be discovered, and that the sensitivity of the        examination is reduced significantly.

Various methods have been developed to reduce these problems ofexaminations with Amsler charts. The PCT application WO 87/04264 A1(System and method of detecting visual field defects), expresslyincorporated herein by reference, discloses a method using eyeglasseshaving a pair of cross-polarizing lenses, which may be variedselectively, so that the Amsler chart may be seen with differentluminance, thus increasing the sensitivity of the examination. In theU.S. Pat. No. 5,646,710 (Ophthalmological self-test for evaluation ofmacular degeneration), expressly incorporated herein by reference, theAmsler chart is provided with a magnetic rear face so that it may beapplied to a metallic surface, and may moreover be provided with acentral fixation object consisting of a light source. The PCTapplication WO 99/26524 A1 (Method and apparatus for measuring andcorrecting metamorphopsia), expressly incorporated herein by references,uses a computer and a monitor on which an Amsler grid may be displayed.With a computer mouse, the patient is able to control a cursor andindicate the areas where parts of the grid cannot be seen (scotoma). Ifthe patient discovers deformations of the grid (metamorphopsia), thecursor may be controlled to adjust these areas, so that all the lines inthe grid become straight. All markings are stored in the computer andmay be compared with subsequent examinations.

U.S. Pat. No. 6,585,376 (Test charts for metamorphopsia) expresslyincorporated herein by reference, discloses a method of quantifyingmetamorphopsia in a horizontal and a vertical direction close to thefixation point. The method consists of different charts, where one ortwo fixation points, a white line or a straight row of white circulardots are printed on a black background. Metamorphopsia may be quantifiedby increasing the size of the dots and the distance between them.

The document US 2004/0061775 A1 discloses a digital binocular fusingapparatus where a stationary lenticular lens array produces a secondary3D image from a primary image on a display mounted behind the lensarray. The display could be a liquid crystal display or anotherelectronic display, which are capable of producing and controllingpixels. The apparatus is designed to produce 3D images and enable visualpresentation of video games and movies without using special eyeglassesor other optical apparatus adjacent the eyes of a viewer.

The document EP 0 830 839 A2 discloses a digital binocular view functioninspecting apparatus for measuring the strabismus angle. A referenceimage for one eye and an index image for the other eye are displayed ona 3D display device. The person to be inspected can with the help of acomputer mouse move the index image until the person visually recognizesthe two images coincide. The computer calculates the actual amount ofdeviation between the two images. The document discloses that the 3Ddisplay could be a display of the parallax barrier type or of thelenticular type. The 3D display is a stationary one.

The document WO 03/092482 A1 discloses an ocular display apparatus forassessment and measuring of and for treatment of ocular disorder. Theapparatus having image presentation means adapted to display a firstimage to one eye only of a subject, and a second, different image to thesubject's other eye only so that the subject perceive a composite imageincluding a moving object.

The apparatus is capable of presenting images to the subject on a splitscreen or on two separate screens. The images are perceived as 2D or 3Dimages. The display screens are stationary.

The document JP 2001 340300 A discloses a pupil detection device and amethod of detecting the pupil position, and a 3D image display system,which use a stationary crossing lenticular system, and infrared lightfor detecting.

SUMMARY AND OBJECTS OF THE INVENTION

Many diseases in the visual system only affect one eye or affect botheyes differently. Clinical examination of the visual field depends on:

-   -   examination objects and presenting time    -   stable central fixation    -   illumination and background    -   correction for distance and refraction anomalies    -   the viewer's visual attention and psychophysical function.

It is very important to obtain a short presenting time of examinationobjects for visual field testing most particularly in the central partof the visual field. The present invention uses a non-texturebackground, shows the fixation area in all examination positions andshows a single or very few examination objects together with thefixation object for a very short interval of time (0.5-2.0 sec). In thatway, the invention makes it possible to reduce the described visualproblems of known examination methods, which apply similar principles tothose of the Amsler grid.

The invention makes it possible to reduce the above-described visualproblems of known examination methods, which apply the same principle asthe Amsler grid. This is done by showing the fixation area in allexamination positions and just showing a single or very few examinationobjects together with the fixation area for a very short interval oftime (0.5-2.0 sec).

When observation direction, examination distance are changed, or thesystem is tilted or rotated to various positions, the fixation area isshown alone or together with one or more examination objects, which aretargeted to examine clinical visual functions.

When switching between various observation directions with a very shorttime interval, problems of unstable fixation, crowding, filling-in andTroxler effect are reduced.

The examination possibilities, sensitivity and specificity of the systemmay be varied by using various lenticular units having various opticalproperties, using various clinically relevant examination objects,various positioning of clinically relevant examination objects, variouscontrast between background and examination objects and various opticalproperties of parts in front of or behind the lenticular unit.

In a simple embodiment, the invention may be produced at a relativelylow price, thereby making it possible for many individuals to use theinvention. In this manner, some pathological visual functions may bediscovered timely, thereby providing for early diagnosis and treatmentof the patient.

In various embodiments, the system may consist of one or more lenticularunits and of one or more supplementary parts. Objects that are to bevisible in all examination positions may be arranged on the rear face ofa lenticular unit, on supplementary parts, in front of, or on, the frontface of lenticular units, in areas of lenticular units where there areno lenticulars, or behind lenticular units at a distance where they arenot affected by lenticular optics.

Fixation areas may be configured as a large or a small area, which maybe unchanged in all examination positions, or may vary position andconfiguration in several of the examination positions of the system.Fixation areas may be black, white or colored.

The clinically relevant examination objects may be printed directly onthe rear face, or on a plate, which is in contact with the rear side ofthe lenticular face. The graphical print may be divided by a specialtechnique into narrow segments corresponding to the lenticular lenses,so that the same or different objects may be visualized by changing theobservation direction or by tilting or rotating the system to variouspositions. The examination objects may be configured as images,drawings, geometrical elements, lines and rows or objects with the sameor different numbers, shapes, sizes and with the same or differentspaces. The objects may be white, grey, black or colored and havevarious positions in the various examination positions of the system.

Supplementary parts, which are arranged in front of or behind lenticularunits, may be plates, which are provided with a different opticalsurface, light transparency, light polarization or color. These platesmay be fixed or moved relative to the lenticular units.

In a preferred embodiment, the system has one or more examinationpositions and one or more recording positions. In examination positions,examination objects are shown for just a few seconds, typically 0.5 to2.0 sec. In recording positions, the examination objects are showntogether with elements in the form of lines, dots, squares, circles orcolors which divide the examination objects into blocks or groups.Recording positions may be maintained for such a long time, typically5.0 to 10.0 sec., that it is easier for the patient to indicate thechanges that were discovered in the examination positions.

In other embodiments, the system may be used for examining someclinically relevant visual functions in various parts of the visualfield. The system may be designed to examine with different sensitivityand specificity by using systems having different clinical, targetedproperties. These systems may be provided with lenticular units havingdifferent functions, or supplementary plates having different opticalproperties and transparencies may be arranged in front of or behind thelenticular units. Further, it is possible to use fixation areas havingdifferent configurations and positions and examination objects ofdifferent numbers, positions, shapes, sizes and colors.

In other embodiments, the fixation area and examination objects may bedisplaced in various directions in various examination positions.

Both monocular and binocular examinations may be performed with theembodiments described. Using lenticular systems having 3D or zoomproperties may perform special binocular examinations.

It is therefore an object to provide a system for clinical examinationof visual system functioning comprising lenticular optics, a movablelenticular unit comprising one or more lenticular plates configured toproject images of a plurality of different examination objects to aviewer dependent on an orientation of the lenticular unit with respectto the viewer along with a fixation area; and a holding part configuredto orient and maintain an orientation of the lenticular unit in desiredorientation with respect to the viewer. The system may further compriseat least one supplementary part configured to visually present an objecthaving a predetermined position with respect to the lenticular unit. Thelenticular unit may comprise a plurality of lenticular plates, each ofthe plurality of lenticular plates having a distinct lens structure. Theexamination objects may comprise a plurality of unique graphic icons.The system may further comprise an optically polarized plate, disposedbetween the viewer and the lenticular unit. The fixation area may have apredetermined position with respect to the examination objects inrespectively different relative orientations of the lenticular unit withrespect to the viewer. The examination objects may be provided in atleast two different colors, and a set of color filter glasses providedfor the viewer corresponding to at least two different colors. Thesystem may further comprise eyeglasses having different lightpolarization for the right eye and the left eye of the viewer. Thesystem may further comprise polarization filters, which are arrangedsuch that the light projected to the viewer from the fixation area isnot polarized, light projected from a first set of examination objectsis polarized in a first direction, and light projected from a second setof examination objects is polarized in a second direction, and thateyeglasses with different light polarization permit visualization of thefixation area and the first set of examination objects by the left eye,and the fixation area and the second set of examination objects by theright eye of the viewer. It is also an object to provide a method forclinical examination of visual system functioning comprising providing amovable lenticular unit comprising one or more lenticular platesconfigured to project images of a plurality of different examinationobjects to a viewer dependent on an orientation of the lenticular unitwith respect to the viewer along with a fixation area; orienting andmaintaining an orientation of the lenticular unit in a desiredorientation with respect to the viewer; and receiving a report of thevisualization of the examination objects from the viewer. An objecthaving a predetermined position with respect to the lenticular unit maybe visually presented. The lenticular unit may comprise a plurality oflenticular plates, each of the plurality of lenticular plates having adistinct lens structure. The examination objects may comprise aplurality of unique graphic icons. An optically polarized sheet may bedisposed between the viewer and the lenticular unit. The fixation areamay have a predetermined position with respect to the examinationobjects in respectively different relative orientations of thelenticular unit with respect to the viewer. The examination objects maybe provided in at least two different colors, further comprising viewingthe examination objects through a set of color filter glassescorresponding to at least two different colors. Eyeglasses havingdifferent light polarization for the right eye and for the left eye ofthe viewer may be provided. Polarization filters may be arranged suchthat light projected to the viewer from the fixation area is notpolarized, light projected from a first set of examination objects ispolarized in a first direction, and light projected from a second set ofexamination objects is polarized in a second direction, and viewing thelenticular unit through eyeglasses with different light polarizationwhich permit visualization of the fixation area and the firstexamination objects by the left eye, and the fixation area and thesecond examination objects by the right eye of the viewer.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a drawing of scotoma marked on an Amsler chart.

FIG. 2 shows a drawing of metamorphopsia marked on an Amsler chart.

FIG. 3 shows a sectional drawing of the system perpendicular to thelongitudinal direction of the lenses in the lenticular face.

FIG. 4 shows a fixation area and examination object integrated usingnumbers in circles.

FIG. 5 shows a fixation area similar to FIG. 4, using characters.

FIG. 6 shows an apparatus for investigating horizontal paracentralscotoma.

FIG. 7 shows an apparatus for investigation using one or moreexamination-objects and 1-2-3 points in the fixation area.

FIG. 8 shows a fixation area similar to FIG. 4, using dots blinkingdifferent times in the fixation area before examination-objects areshown.

FIG. 9 shows an examination object with a line and a row of dots.

FIG. 10 illustrates a scotoma and area with metamorphopsia.

FIG. 11A shows an examination object consisting of rings.

FIG. 11B shows an examination object consisting of dots arranged in acircular manner.

FIG. 12 shows a fixation area displaying examination objects differentplaces in circles around the center.

FIG. 13 illustrates scotoma and metamorphopsia.

FIG. 14 shows a scale showing the position in degrees from the verticalposition.

FIG. 15 shows a block diagram of a computer system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Movable Lenticular Cards

The earliest lenticular techniques have been known since around 1940 andhave subsequently been developed considerably and used for obtainingdifferent binocular visual functions:

US 2004/0061775 A1 (Apparatus for placing primary image in registrationwith lenticular lens in system for using binocular fusing to producesecondary 3D image from primary image) is a digital binocular fusingapparatus where a stationary lenticular lens produces a secondary 3Dimage from the primary image on a display mounted behind the lens arrayand a primary image orientation adjustment system with sensors.

EP 0 830 839 A2 (Binocular view function inspecting apparatus andinspecting method) shows a system where a reference image for one eyeand an index image for the other eye are displayed on a 3D displaydevice. The person to be examined can move the index image until he orshe visually recognizes the two images coincide. A computer calculatesthe amount of deviation between the two images.

JP 2001 340300 A (Pupil detecting device and method, fixation pointdetecting device and method, and three-dimensional image display system)uses a stationary crossing lenticular system and infrared light fordetecting.

US 2008/0252718 A1 (Enhancement of visual perception) shows a systemwhere a 2D image is enhanced by inducing a retinal disparity in theviewer that results in a fusion experience. An enhancer generates avirtual visually identical object by a holographic device, concavemirror projection device or with a lenticular device.

These systems use stationary lenticular devices in contrast to thepresent invention where movable lenticular cards are used to obtainshort presenting time of examination objects.

A lenticular unit consists of a lenticular plate and rear face which ismade by a special graphical technique such that, from this rear face,the lenticular plate is capable of showing clinically useful examinationobjects and fixation areas in the various examination positions of thesystem.

The lenticular plates may have the same or different optical properties.Lenticular plates may consist of one or more layers of rows oftransparent, parallel lenses (lenticulars). Lenticular plates may beconfigured with the same or different lens shapes, lens sizes, numbersand densities of the lenses and in several layers, so that variousoptical properties may be provided by the system.

The clinically useful examination objects may be printed directly on therear face, or on a plate (FIG. 3), which is in contact with the rearside of the lenticular face. The graphical print may be divided by aspecial technique into narrow segments corresponding to the lenticularlenses, so that the same or different objects may be visualized bychanging the observation distance, observation direction, or by tiltingor rotating the system to various positions.

That is, the lenticular card may be provided in which the fixation areawhich is visible over a wide range of viewing angles, with differentexamination patterns selectively visible in different viewing positions,while fixing gaze on the always visible fixation area. Thus, the virtualmovement or reconfiguration of the examination patterns is possible byshifting the angle of a relatively simple examination card.

When observation direction, examination distance are changed, or thesystem is tilted or rotated to various positions, the fixation area isshown alone or together with one or more examination objects, which aretargeted to examine clinical visual functions. When switching betweenvarious observation directions with a very short interval of time,problems of unstable fixation, crowding, filling-in and Troxler effectmay be reduced according to the invention.

The examination possibilities, sensitivity and specificity of the systemmay be varied by using various lenticular units having various opticalproperties, using various examination objects, various positioning ofexamination objects, various contrast between background and examinationobjects and various optical properties of parts in front of or behindthe lenticular unit.

In the present invention one embodiment constitutes a system of one ormore lenticular units provided on cards, and of supplementary parts,which are necessary for the use of the system.

Supplementary Parts

The supplementary parts, which generally do not have lenticularstructures, may consist of one or more mounting parts, holders andcouplings, for which one or more lenticular units are arranged. Mountingparts may have the same or different colors and different transparenciesto light.

The supplementary parts may moreover consist of plates, which aredisposed in front of and behind the lenticular units. These plates maybe more or less transparent to light, have different colors anddifferent light polarizations.

A fixation area having the same or a movable position relative to thelenticular units may be applied to the supplementary parts.

The mounting parts may, for example, hold the card in a stable mannersuch that the angle of gaze, and thus the intended examination pattern,can be controlled and changed. For example, a card mount may have atelescoping or deployable end (such as a tape measure), to help ensurethe correct working 12 inches distance, and define the normal angle tothe nose. The card is supported by a clamp at the base of the deployableend, having a set of angular detents. In a typical case, the printingbehind the lenticular screen will have 15 degree offset viewing angles,and provide eight superposed images. The angular detents are thereforeprovided at 15-degree intervals. The locking force need not be high. Forexample poled flexible ceramic magnets slipping against each other couldcreate such forces. The supplementary parts, such as a fixation object,may extend from the clamp or element close to the clamp.

In various embodiments, the system may consist of one or more lenticularunits and optionally of one or more supplementary parts. Objects whichare to be visible in all examination positions (FIG. 3), may be arrangedon the rear face of a lenticular unit, on supplementary parts, in frontof (1) the face of lenticular units (2), in areas of lenticular unitswhere there are no lenticulars, or behind lenticular units (4) at adistance where they are not affected by lenticular optics.

Supplementary parts (FIG. 3), which are arranged in front of (1) orbehind (4) lenticular units (2), may be plates which are provided with adifferent optical surfaces, light transparency, light polarization orcolor. These plates may be fixed or moved relative to the lenticularunits.

In an embodiment, the system has one or more examination positions andone or more recording positions. In examination positions, examinationobjects are shown for just a few seconds, typically 0.2 to 0.5 sec. Inrecording positions, the examination objects are shown together withelements in the form of lines, dots, squares, circles or colors whichdivide the examination objects into blocks or groups. Recordingpositions may be maintained for such a long time, typically 5.0 to 10.0sec., that it is easier for the patient to indicate the changes, whichwere discovered in the examination positions.

In other embodiments, the system may be used for examining someclinically relevant visual functions in various parts of the visualfield. The system may be designed to examine with different sensitivityand specificity by using systems having different clinical, targetedproperties. These systems may be provided with lenticular units havingdifferent functions, or supplementary plates having different opticalproperties and transparencies may be arranged in front of or behind thelenticular units. Further, it is possible to use fixation areas havingdifferent configurations and positions and examination objects ofdifferent numbers, positions, shapes, sizes and colors. In otherembodiments, the fixation area and examination objects may be displacedin various directions in various examination positions.

Both monocular and binocular examinations may be performed with theembodiments described.

Fixation Area and Examination Objects

Attention to the Fixation Area

In automatic perimetry, clinically relevant examination objects areshown between 0.5-2.0 seconds in different parts of the visual field. Inthat way the patient's eye or eyes cannot react to shift from thecentral fixation area. This method could be improved by constantlyobserving the patient's fixation and vocally correcting the patient ifthe fixation shifts. An eye-tracking system may also be used.

To have a higher degree of attention to the fixation area and get astable fixation, examination objects are placed in the fixation area andintegrated with the examination objects in the visual field. FIG. 4shows such a system: Both the fixation area and the examination objectconsist of a circular ring and inside the ring is a number. Theexamination object and the number in the fixation area are displayedtogether very shortly. The ring in the fixation area is shownconstantly. Every time a new examination object is shown it has adifferent number in the ring and the ring in the fixation area has a newnumber. The patient has to read all the numbers aloud for notation by anobserver, or otherwise to transcribe it or input it into a digitalsystem. Instead of numbers, characters could be used as shown in FIG. 5.The system is useful as an indicator for visual attention. Preferably,the number, letters or images do not follow a predicable order, so thatthe user cannot infer a missing examination object.

Normal reading could be difficult if the patient has paracentral scotomain a horizontal line 2 degree high and 4 degree long around the center.To test for these paracentral scotoma in this area, the system maydisplay 10 or more different characters without a ring, one at a time atdifferent places in the area together with different characters in thefixation area, as shown in FIG. 6.

FIG. 7 illustrates a program using one or more other examination points.In this embodiment, a computer-implemented testing system is providedrun by a program, which controls the system to display one, two or threepoints in a random or unpredictable (by the testing subject) manner inthe fixation area. The patient has to tell, print or place in a digitalsystem how many points in all are in the fixation area, together withone or more examination-points.

FIG. 8 illustrates a system run by a program in which, inside the ringin the fixation area, a dot blinks at different times. After the lastblink the examination object is shown. Instead of a blinking dot somenumbers could be shown counting up or down.

Using lenticular cards, the examiner can monitor the patient and controlthe patient's stable central fixation. The examiner or the patient canhold the card so that the examiner can see the patient's eye or eyes.For controlling and registration, the correct patient's answers for arespective lenticular unit can be placed on the rear side of the unit,providing the examiner information simultaneously with the test shownfor the patient.

Specialized Examination Objects

The examination objects may be constructed for targeted use in clinicalexaminations of visual functions. Examination objects can be shown indifferent sizes, colors or contrast to the background. The test can beperformed with static or movable objects. To test the patient'scooperation, sometimes only points or numbers in the fixation area areshown or only examination point(s) in the visual field.

Specialized objects may be used together with the objects for attentionof the fixation area:

-   1. Test for scotoma: A circular ring with a number or character    inside the ring (FIGS. 4-5) is displayed in different sizes,    different thickness of the ring and different numbers and    characters, different contrast to the background and different    colors. Together with the fixation area mentioned in FIGS. 4-5 and    FIGS. 7-8, circular dots could be used.-   2. Test for metamorphopsia and scotoma: These examination objects    are special for monocular tests. FIG. 9 illustrates an examination    object consisting of a line (thickness 0.1-0.3 mm, length 20-100 mm)    and, parallel to this in a distance of 3-5 mm, a row of circular    dots (diameter 0.1-0.3 mm and the same distance between dots, length    20-100 mm). The line and the row of dots can be used with different    contrast to the background and with color. The examination object    could be presented in horizontal or vertical position. As shown in    FIG. 10 the patient has to observe something missing of the line    or/and dots (scotoma) and somewhere the line or/and the row of dots    are bending or deformed (metamorphopsia).-   3. FIGS. 11A-11B Illustrate a examination object consisting of 2 and    4 concentric rings (thickness 0.1-0.3 mm) or circular rings    consisting of dots (diameter 0.1-0.3 mm) and with distance between    the rings of 3 to 5 mm. The examination object consists of only    rings or rings of dots or a mixture and all the rings could have the    same or different contrast to the background or the same color or    different colors (e.g., Red-Green-Blue) for testing different    sensitivity of functional changes in the visual field. The    examination object could be presented in different places in the    visual field as shown in FIG. 12, where the examination object is    presented in different places in circles around the center and where    the patient has to observe FIG. 13 something missing of the rings    (scotoma) or/and are rings or part of rings deformed    (metamorphopsia). Using lenticular units, the unit could be rotated    clockwise or anti-clockwise, with the unit (FIG. 14) having a scale    outside the testing area showing the unit position in degrees from    the vertical position. The same sort of scale could be placed on the    backside for the examiner's information.    Test Background

The background is non-textured and could be black, different degrees ofgray, and of various colors. A rear face for a lenticular unit (FIG. 3)may be white, grey, black or colored and more or less transparent tolight. To make the method more sensitive, the background could bepopulated with visual noise, for example, small black and white spotsflickering randomly. In programmable displays, this can be made by asoftware program and with lenticular cards by using multi-frames cards.

Binocular Function Test

Many apparatus have been developed for testing binocular functions whereimages are shown stationary or with some moving objects. In WO 03/092482A1 (Ocular display apparatus for assessment and measurement of and fortreatment of ocular disorders, and methods therefor) a first image isdisplayed to one eye only, and a second, different image, to the othereye only so that the person being examined perceives a composite imageincluding a moving object.

According to one aspect of the present invention, binocular functionsmay be tested by presenting objects and images for a short time period(0.2-2.0 seconds). The vision from right and left eye is separated usingcolor or polarization methods. Also the separation could be performedwith a perpendicular structure, so that the right eye can only see theright part of the lenticular unit, and the left eye only can see theleft part. Using lenticular units having 3D or zoom properties mayperform special binocular examinations.

The Preferred Embodiments for the System Using Lenticular Cards

The preferred embodiment consists of one lenticular card or twolenticular cards placed back to back. When using two cards, the one sideof the unit can be used for examining the right eye and the other sidefor examining the left eye, or the two cards could have differentexamination objects or backgrounds.

The lenticular card or cards are surrounded by a plastic film, which canbe moved over the lenticular card, or at the same time over both sidesof the lenticular cards (FIG. 15). The fixation area is printed on theplastic film. By moving the plastic film the fixation area can be placedin different distances to the examination objects. In that way it ispossible to scan the examination area.

On the plastic film, parts are printed with different transparency,colors, polarization and lenticular parts. When moving the plastic film,different parts of the lenticular card could be hidden or exposed.Instructions to the patient can also be printed on the plastic film andhidden or exposed when the plastic film is moved.

The patient observations of scotoma and metamorphopsia of theexamination objects can be indicated with a pen directly on the plasticfilm, so it is possible to have complete marking on the plastic film ofall the patient observations. In this case, the plastic film may beremovable, and thus the patient observations on the film retained aspart of the file.

The preferred supplementary embodiment for the system using lenticularcards is a seesaw device with an axis parallel with the lenticulars ofthe lenticular card. Lenticular cards can be tilted to an exactinclination angle where the examination objects are shown for a definedtime and then the lenticular cards are tilted back to the primaryposition. The tilting movements can be carried out mechanically or withan electrical system, such as a bimetallic element, memory metalactuator, piezoelectric actuator, or solenoid. Different inclinationangles can be chosen. In that way, it becomes possible to compareresults of examination data from different examinations of the samepatient or with examinations of other patients.

A timer or alarm may be provided with or as part of the system. Theperiods may be denoted by an audible or visual alarm, or the alarm maychange a visibility of a pattern, such as by causing an inclination ofthe lenticular card or activation of a mechanical or electrical lightshutter. In the same way a voice chip system with instructions for thepatient can be provided together with the system.

The Preferred Programmable Display for the System

Programmable displays can be correspondingly used according to similarprotocols as used with lenticular units, using non-texture background,short presenting time of the examination objects and high attention tothe fixation area. In a computerized embodiment, the human interface andtiming elements can be fully automated.

The invention may be implemented as a software program for operating ageneric device, with the software stored in non-transitory form in acomputer readable memory and executed by a programmable processor.

The preferred programmable display can use different programs, which canbe stored and the result of the test may be analyzed, stored and showedon the same display, along with instructions for the test. Instructionscan also be given vocally by the programmable display system.

The preferred size of the display for the system is 100×100 mm or more,but smaller displays can be used, when the fixation areas are changed inthe program from left-right-up-down, to close to the edge of thedisplay. It is important, that the display has a high-resolutionquality. Thus, the display may test a single quadrant of vision, with afixation area in a corner of the card, thus permitting a 50 mm×50 mmdisplay.

Registration of patient observations can be made on a transparent filmover the display or it is preferred to use a programmable electronicdisplay with an overlying touch-screen. This would facilitate patientinput of where the examination objects and deformation of examinationobjects are seen.

A user-facing camera in the programmable display can be used to controlthe patient attention to the fixation area.

Programmable displays with 3D capability make it useful for binoculartest and simultaneously test of both eyes. Preferably, the 3D displaydoes not require special glasses, though LCD shutter glasses may beused.

A 3D viewable electronic display may be provided by placing a lenticularsheet over a display, aligned such that alternate columns of pixels aredirected by the lenticular sheet to the right and left eyes,respectively, at a define viewing distance range. In this case, thedisplay remains normal to the viewing axis at all times, and changingthe electronic information delivered to the display alters the imagespresented to each eye. Since the standard Amsler display is 100×100 mm,this permits a relatively inexpensive display system (using the standardAmsler size or larger), similar to an electronic photo frame, whichindeed can be programmed to display a series of compressed digitalimages (e.g., JPEG) at a controlled rate. Therefore, few if anymodifications other than the addition of an appropriate lenticular lenssheet over the display are necessary to obtain an electronic displayunit according to the present technologies. The electronic display canbe programmed according to various testing paradigms as required topresent and/or fully administer the test. A more advanced controller,such as a smartphone, tablet, netbook or notebook computer, could beprogrammed to provide other features, such as adaptive testing in orderto fully define any deficiencies, while avoiding excess testing fornormal areas of the visual field. Thus, according to one embodiment, anApple iOS 5 applet or Android 2.3 or 3.1 applet could be created toimplement the examination on a smartphone or tablet device. In somecases, a 3D-type display may be provided on a programmable displaydevice, to provide a dynamic examination system with binolculardiscrimination.

With programmable displays, all methods for separating vision from rightand left eye could be used for testing binocular function and byalternating special examination objects for the right and left eye, bothcould be examined. A pair of displays may also be provided.

The system using a programmable display is well suited for self-test.

The present technology provides in various embodiments a number ofuseful features:

-   -   Using movable lenticular cards or programmable displays to        obtain short presenting time (0.2-2.0 seconds) of examination        objects for both monocular and for binocular testing.    -   Testing for both scotoma and metamorphopsia in the central        visual field.    -   Registering patient observations on supplementary parts in front        of a lenticular card or a display or registration on a        touch-screen.    -   Presenting fixation area with higher attention.    -   Presenting specialized examination objects.    -   Incorporating supplementary embodiments for tilting lenticular        cards to an exact inclination angle and observation time.    -   Portable system.    -   Offering flexibility to be used by eye care professionals and        for self-test.        Description of the Course of Examination

Most patients prefer testing at their normal reading distance (about 350mm). When the patient wears his or her eyeglasses or reading glasses,blurring of examination objects could be avoided.

The examination may be performed under the guidance and observation of askilled person, or the patient may learn how to perform the examination.The system, e.g., lenticular card or display, is held at the distancefrom the eye and in the orientation, which have been indicated for thesystem. A fixture may be provided to assist in positioning. In case ofmonocular examination, generally first the right eye and then the lefteye are examined.

In examinations with systems where the right eye and the left eye arepresented with examination objects of different colors or lightpolarizations, the patient has to use eyeglasses having different colorsor different light polarizations for the right eye and the left eye todistinguish these objects.

At the beginning of the examination, the patient is instructed toobserve specific changes of the examination objects in the form ofobjects being missing or being seen weakly, in the form of lines or rowsof small objects being seen curved, wavy or with bends. If the patientdiscovers some of these changes, then the patient or an assistant asinstructed by the patient may mark these changes directly on the system,on a transparent plate which covers the unit completely or partly, ormark the changes on a form at the side of the system.

Various aspect of the technology may be implemented on an automatedcomputer using known components. The computer may be controlled inaccordance with a tangible computer-readable medium, such as a magneticdisk, optical disk, flash memory, and other physical systems. Theautomated computer itself typically comprises a processor, which may beCISC, RISC, SIMD, multicore, ARM, Intel architecture, or other types.

Embodiments hereof may be implemented as a method, apparatus, or articleof manufacture using standard programming and/or engineering techniquesto produce software, firmware, hardware, or any combination thereof tocontrol a computer to implement the disclosed embodiments. The term“article of manufacture” (or alternatively, “computer program product”)encompasses a computer program accessible from any computer-readabledevice, carrier, or media. For example, computer readable media caninclude but are not limited to magnetic storage devices (e.g., harddisk, floppy disk, magnetic strips, etc.), optical disks (e.g., compactdisk (CD), digital versatile disk (DVD), BlueRay disks, etc.), smartcards, and flash memory devices (e.g., card, stick). Additionally itshould be appreciated that various types of information can becommunicated using a carrier wave such as those used in transmitting andreceiving electronic mail or in accessing a network such as the Internetor a local area network (LAN). In some cases, these carrier waves residewithin tangible media, and can be deemed non-transitory. Of course,those skilled in the art will recognize many modifications may be madeto this configuration without departing from the scope or spirit of thedisclosed embodiments.

Referring now to FIG. 15, there is illustrated a block diagram of acomputer operable to execute the disclosed architecture. In order toprovide additional context for various aspects disclosed herein, FIG. 15and the following discussion are intended to provide a brief, generaldescription of a suitable computing environment 1100 in which thevarious aspects can be implemented. While the one or more embodimentshave been described above in the general context of computer-executableinstructions that may run on one or more computers, those skilled in theart will recognize that the various embodiments also can be implementedin combination with other program modules and/or as a combination ofhardware and software.

Generally, program modules include routines, programs, components, datastructures, etc., that perform particular tasks or implement particularabstract data types. Moreover, those skilled in the art will appreciatethat the inventive methods can be practiced with other computer systemconfigurations, including single-processor or multiprocessor computersystems, minicomputers, mainframe computers, as well as personalcomputers, hand-held computing devices, microprocessor-based orprogrammable consumer electronics, and the like, each of which can beoperatively coupled to one or more associated devices.

The illustrated aspects may also be practiced in distributed computingenvironments where certain tasks are performed by remote processingdevices that are linked through a communications network. In adistributed computing environment, program modules can be located inboth local and remote memory storage devices.

A computer typically includes a variety of computer-readable media.Computer-readable media can be any available media that can be accessedby the computer and includes both volatile and nonvolatile media,removable and non-removable media. By way of example, and notlimitation, computer-readable media can comprise computer storage mediaand communication media. Computer storage media includes both volatileand nonvolatile, removable and non-removable media implemented in anymethod or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. Computer storage media includes, but is not limited to, RAM,ROM, EEPROM, flash memory or other memory technology, CD-ROM, digitalvideo disk (DVD) or other optical disk storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by the computer.

Communication media typically embodies computer-readable instructions,data structures, program modules or other data in a modulated datasignal such as a carrier wave or other transport mechanism, and includesany information delivery media. The term “modulated data signal” means asignal that has one or more of its characteristics set or changed insuch a manner as to encode information in the signal. By way of example,and not limitation, communication media includes wired media such as awired network or direct-wired connection, and wireless media such asacoustic, RF, infrared and other wireless media. Combinations of the anyof the above should also be included within the scope ofcomputer-readable media.

With reference again to FIG. 15, the exemplary environment 1100 forimplementing various aspects includes a computer 1102, the computer 1102including a processing unit 1104, a system memory 1106 and a system bus1108. The system bus 1108 couples system components including, but notlimited to, the system memory 1106 to the processing unit 1104. Theprocessing unit 1104 can be any of various commercially availableprocessors. Dual microprocessors and other multi-processor architecturesmay also be employed as the processing unit 1104.

The system bus 1108 can be any of several types of bus structure thatmay further interconnect to a memory bus (with or without a memorycontroller), a peripheral bus, and a local bus using any of a variety ofcommercially available bus architectures. The system memory 1106includes read-only memory (ROM) 1110 and random access memory (RAM)1112. A basic input/output system (BIOS) is stored in a non-volatilememory 1110 such as ROM, EPROM, EEPROM, which BIOS contains the basicroutines that help to transfer information between elements within thecomputer 1102, such as during start-up. The RAM 1112 can also include ahigh-speed RAM such as static RAM for caching data.

The computer 1102 further includes an internal hard disk drive (HDD)1114 (e.g., EIDE, SATA), which internal hard disk drive 1114 may also beconfigured for external use in a suitable chassis (not shown), amagnetic floppy disk drive (FDD) 1116, (e.g., to read from or write to aremovable diskette 1118) and an optical disk drive 1120, (e.g., readinga CD-ROM disk 1122 or, to read from or write to other high capacityoptical media such as the DVD). The hard disk drive 1114, magnetic diskdrive 1116 and optical disk drive 1120 can be connected to the systembus 1108 by a hard disk drive interface 1124, a magnetic disk driveinterface 1126 and an optical drive interface 1128, respectively. Theinterface 1124 for external drive implementations includes at least oneor both of Universal Serial Bus (USB) and IEEE 1394 interfacetechnologies. Other external drive connection technologies are withincontemplation of the one or more embodiments. The drives and theirassociated computer-readable media provide nonvolatile storage of data,data structures, computer-executable instructions, and so forth. For thecomputer 1102, the drives and media accommodate the storage of any datain a suitable digital format. Although the description ofcomputer-readable media above refers to a HDD, a removable magneticdiskette, and a removable optical media such as a CD or DVD, it shouldbe appreciated by those skilled in the art that other types of mediawhich are readable by a computer, such as magnetic hard drives, flashmemory cards, optically readable media, and the like, may also be usedin the exemplary operating environment, and further, that any such mediamay contain non-transitory computer-executable instructions forperforming the methods disclosed herein.

A number of program modules can be stored in the drives and RAM 1112,including an operating system 1130, one or more application programs1132, other program modules 1134 and program data 1136. All or portionsof the operating system, applications, modules, and/or data can also becached in the RAM 1112. It is appreciated that the various embodimentscan be implemented with various available operating systems orcombinations of operating systems.

A user can enter commands and information into the computer 1102 throughone or more wired/wireless input devices, e.g., a keyboard 1138 and apointing device, such as a mouse 1140. Other input devices (not shown)may include a microphone, a remote control, a joystick, a game pad, astylus pen, touch screen, or the like. These and other input devices areoften connected to the processing unit 1104 through an input deviceinterface 1142 that is coupled to the system bus 1108, but can beconnected by other interfaces, such as a parallel port, an IEEE 1394serial port, a game port, a USB port, an interface, etc.

A monitor 1144 or other type of display device is also connected to thesystem bus 1108 through an interface, such as a video adapter 1146. Inaddition to the monitor 1144, a computer typically includes otherperipheral output devices (not shown), such as speakers, printers, etc.

The computer 1102 may operate in a networked environment using logicalconnections through wired and/or wireless communications to one or moreremote computers, such as a remote computer(s) 1148. The remotecomputer(s) 1148 can be a workstation, a server computer, a router, apersonal computer, portable computer, microprocessor-based entertainmentappliance, a peer device or other common network node, and typicallyincludes many or all of the elements described relative to the computer1102, although, for purposes of brevity, only a memory/storage device1150 is illustrated. The logical connections depicted includewired/wireless connectivity to a local area network (LAN) 1152 and/orlarger networks, e.g., a wide area network (WAN) 1154. Such LAN and WANnetworking environments are commonplace in offices and companies, andfacilitate enterprise-wide computer networks, such as intranets, all ofwhich may connect to a global communications network, e.g., theInternet.

When used in a LAN networking environment, the computer 1102 isconnected to the local network 1152 through a wired and/or wirelesscommunication network interface or adapter 1156. The adaptor 1156 mayfacilitate wired or wireless communication to the LAN 1152, which mayalso include a wireless access point disposed thereon for communicatingwith the wireless adaptor 1156.

When used in a WAN networking environment, the computer 1102 can includea modem 1158, or is connected to a communications server on the WAN1154, or has other means for establishing communications over the WAN1154, such as by way of the Internet. The modem 1158, which can beinternal or external and a wired or wireless device, is connected to thesystem bus 1108 through the serial port interface 1142. In a networkedenvironment, program modules depicted relative to the computer 1102, orportions thereof, can be stored in the remote memory/storage device1150. It will be appreciated that the network connections shown areexemplary and other means of establishing a communications link betweenthe computers can be used.

The computer 1102 is operable to communicate with any wireless devicesor entities operatively disposed in wireless communication, e.g., aprinter, scanner, desktop and/or portable computer, portable dataassistant, communications satellite, any piece of equipment or locationassociated with a wirelessly detectable tag (e.g., a kiosk, news stand,restroom), and telephone. This includes at least IEEE-802.11x (Wi-Fi),IEEE-802.15 (Bluetooth™), and IEEE-802.16 (WiMax) wireless technologies.Thus, the communication can be a predefined structure as with aconventional network or simply an ad hoc communication between at leasttwo devices.

What has been described above includes examples of the variousembodiments. It is, of course, not possible to describe everyconceivable combination of components or methodologies for purposes ofdescribing the various embodiments, but one of ordinary skill in the artmay recognize that many further combinations and permutations arepossible. Accordingly, the subject specification intended to embrace allsuch alterations, modifications, and variations that fall within thespirit and scope of the appended claims.

In particular and in regard to the various functions performed by theabove described components, devices, circuits, systems and the like, theterms (including a reference to a “means”) used to describe suchcomponents are intended to correspond, unless otherwise indicated, toany component which performs the specified function of the describedcomponent (e.g., a functional equivalent), even though not structurallyequivalent to the disclosed structure, which performs the function inthe herein illustrated exemplary aspects. In this regard, it will alsobe recognized that the various aspects include a system as well as acomputer-readable medium having computer-executable instructions forperforming the acts and/or events of the various methods. In addition,while a particular feature may have been disclosed with respect to onlyone of several implementations, such feature may be combined with one ormore other features of the other implementations as may be desired andadvantageous for any given or particular application. Furthermore, tothe extent that the terms “includes,” and “including” and variantsthereof are used in either the detailed description or the claims, theseterms are intended to be inclusive in a manner similar to the term“comprising.” See, U.S. Pat. No. 7,822,699, expressly incorporatedherein by reference.

It should be understood that the various embodiments of the inventionmay be combined and sub-combined in all possible consistentpermutations. The scope of the invention is limited only by the claims,and no disclosed or preferred embodiment should be interpreted aslimiting the generality of the invention.

What is claimed is:
 1. A system for clinical examination of visualsystem functioning comprising: a movable lenticular unit comprising afixation area and one or more lenticular plates configured to projectimages of a plurality of different examination objects to a viewerdependent on an orientation of the lenticular unit with respect to theviewer gazing toward the fixation area; and a holding part configured toorient and maintain an orientation of the lenticular unit in desiredorientation with respect to the viewer, such that the respectiveexamination object remains projected on the retina of the viewer whilethe viewer gazes toward the fixation area during the clinicalexamination.
 2. The system according to claim 1, further comprising atleast one supplementary part configured to visually present an objecthaving a predetermined position with respect to the lenticular unit. 3.The system according to claim 1, wherein the lenticular unit comprises aplurality of lenticular plates, each of the plurality of lenticularplates having a distinct lens structure.
 4. The system according toclaim 1, wherein the examination objects comprise a plurality of uniquegraphic icons.
 5. The system according to claim 1, further comprising anoptically polarized plate, disposed between the viewer and thelenticular unit.
 6. The system according to claim 1, wherein thefixation area has a predetermined position with respect to theexamination objects in respectively different relative orientations ofthe lenticular unit with respect to the viewer.
 7. The system accordingto claim 1, wherein the examination objects are provided in at least twodifferent colors, further comprising a set of color filter glasses forthe viewer corresponding to at least two different colors.
 8. The systemaccording to claim 1, further comprising eyeglasses having differentlight polarization for the right eye and the left eye of the viewer. 9.The system according to claim 1, further comprising polarizationfilters, which are arranged such that the light projected to the viewerfrom the fixation area is not polarized, light projected from a firstset of examination objects is polarized in a first direction, and lightprojected from a second set of examination objects is polarized in asecond direction, and that eyeglasses with different light polarizationpermit visualization of the fixation area and the first set ofexamination objects by the left eye, and the fixation area and thesecond set of examination objects by the right eye of the viewer.
 10. Amethod for clinical examination of visual system functioning comprising:providing a movable lenticular unit comprising one or more lenticularplates configured to project images of a plurality of differentexamination objects to a viewer dependent on an orientation of thelenticular unit with respect to the viewer whose gaze is directed towarda fixation area; orienting and maintaining an orientation of thelenticular unit in a desired orientation with respect to the viewer,such that the respective examination object remains projected on theretina of the viewer while the viewer gazes toward the fixation areaduring the clinical examination; and receiving a report of thevisualization of the examination objects from the viewer.
 11. The methodaccording to claim 10, further comprising visually presenting an objecthaving a predetermined position with respect to the lenticular unit. 12.The method according to claim 10, wherein the lenticular unit comprisesa plurality of lenticular plates, each of the plurality of lenticularplates having a distinct lens structure.
 13. The method according toclaim 10, wherein the examination objects comprise a plurality of uniquegraphic icons.
 14. The method according to claim 10, further comprisingdisposing an optically polarized sheet between the viewer and thelenticular unit.
 15. The method according to claim 10, wherein thefixation area has a predetermined position with respect to theexamination objects in respectively different relative orientations ofthe lenticular unit with respect to the viewer.
 16. The method accordingto claim 10, wherein the examination objects are provided in at leasttwo different colors, further comprising viewing the examination objectsthrough a set of color filter glasses corresponding to at least twodifferent colors.
 17. The method according to claim 10, furthercomprising providing eyeglasses having different light polarization forthe right eye and for the left eye of the viewer.
 18. The methodaccording to claim 10, further comprising arranging polarization filterssuch that light projected to the viewer from the fixation area is notpolarized, light projected from a first set of examination objects ispolarized in a first direction, and light projected from a second set ofexamination objects is polarized in a second direction, and viewing thelenticular unit through eyeglasses with different light polarizationwhich permit visualization of the fixation area and the firstexamination objects by the left eye, and the fixation area and thesecond examination objects by the right eye of the viewer.
 19. A systemfor clinical examination of visual system functioning comprising: areorientable lenticular unit comprising a fixation area for direction ofa viewer gaze, and at least one lenticular plate comprising a pluralityof parallel cylindrical lenses, configured to project focused images ofeach of a plurality of different examination objects on a retina of aviewer, a selection of a respective examination object for projection asa focused image on the retina of the viewer being dependent on at leastan orientation of the at least one lenticular unit with respect to theviewer, while the viewer gazes toward the fixation area; and a holderconfigured to orient and maintain an orientation of the lenticular unitin desired orientation with respect to the viewer during the clinicalexamination, such that the respective examination object remainsprojected on the retina of the viewer while the viewer gazes toward thefixation area during the clinical examination.
 20. The system accordingto claim 19, wherein the reorientable lenticular unit comprises aplurality of lenticular plates, each of the plurality of lenticularplates having a distinct cylindrical lens structure.